Saturday, April 7, 2012


When I got back to Tonj to pack my things, I met Annie. She is one of the Kenyan nurse-midwife hired to replace me. That first night I didn’t have much time to talk, but by morning I was bursting with things to say.

It was handing-over time.

But how do I tell her two years worth of lessons in three days? How do I show her all the birthing positions and Dinka preferences? How do I explain the superstitions in such a way that she’d understand?


But I was soon to learn that Annie was as keen to learn as I was to teach.

What a blessing!

That first morning as I walked Annie through the prenatal system and explained the medicines used, I rambled on and on about the beliefs and practices I’d seen over the years.

I wanted so much for her to learn and accept the Dinka’s traditions. Knowing that the biggest hurdle she’d encounter would be the Dinka birthing positions, I started there.

-- “The women here have many birthing preferences,” I started to explain, “If you respect them, they will flock to deliver with you. If you don’t, they’ll disappear.”
She nodded pleasantly in response, then asked, “What are these preferences?”
-- “Well... to start, they give birth on their knees...” I paused to watch her face, knowing full-well that such an idea can be strange for most African-trained nurses.
-- “Their knees!” she half laughed, half gauffed, “Why do they do that?”

Annie and Margaret during devotions.
I explained the whys and hows, even falling to the floor to show her the crouch-squat myself. She smiled while I spoke, shaking her head in disbelief.

-- “Okay,” she finally agreed, “but I have never delivered a baby like that... how do you do it?”
Relieved that she was at least willing, I explained the hows and what-nots involved.

She listened attentively, but I could see it was well past her comfort zone. Finally, I added, “Perhaps we’ll have a birth together before I leave. If so, call for me and I’ll show you what I mean.”

She readily agreed and I continued her orientation. There was so much to tell her... and so little time.

I prayed we’d have a birth together for two reasons. One, I desperately wanted to show her how easy it was to deliver a baby in that position. And two, I selfishly desired one last birth in South Sudan.

Our chance came the following night, when I heard a slight knock at my door. It was Annie.
-- “A mama has come in labor,” she started. “I know it’s late, but I’d love if you’d show me how things are done.”
To hear her speak in such a way melted my heart. I could see that she genuinely wanted to work in a culturally sensitive way. Smiling, I agreed to come right over.

My scrubs were packed so I slipped into my jeans and headed over.

Sure it was 1 a.m. and I was tired from my constant packing, but I could think of no place I’d rather be.

Blessed by her eagerness, I talked Annie through the birthing customs as we labor watched. Describing a kneeling birth is harder than I thought. It’s truly a watch-what-I-do kind of thing.

So as the laboring mama progressed from 8 cm to fully, I taught Annie the questions to ask and how to set up the room.

Our labor, Ajak, was expecting her 8th child. Her first seven were all delivered at home, but this time she had decided to deliver with us. I was honored by this choice as it revealed the depth of trust we’d developed in the community over the years.

Her friend, a woman I’d seen many times before, acted as her doula. She never left her side, encouraging Dinka style with sharp comments and disapproving clicks of her tongue.

Ajak’s labor was slow to progress, and her doula-friend disapproved. She kept clicking her tongue impatiently, and speaking gruff remarks. After the third negative comment, I had had enough and I turned to her and asked, “Why are you so upset?”

She looked at me in confusion, so I continued on. “Right now, Ajak is having a normal labor. Everything is okay. I need you to know that so you do not worry... or make her worry.”

I smiled politely while I spoke, but my words were sharp. “Please, if you stay in this room, be happy with your words... I don’t want her to think things are wrong when they are not.”

Her doula friend smiled in agreement, explaining she was tired. Looking around the room, we all laughed with her, and agreed that three o-clock in the morning was rough.

Annie silently took it all in. No doubt watching Ajak labor on the floor was new to her, but she embraced it.

I loved her for this.

We talked softly as Ajak moved about. After several hours, she was finally ready to push. So I asked her, “How do you want to deliver --on the bed or on the floor?”
She looked up at me in surprise, eyes flashing in relief and respect. But she didn’t answer. I could see she was hesitant to speak, so I asked again.
-- “Ajak, do you prefer to give birth on your back or kneeling?”
-- “Kneeling,” she whispered with a smile. Her whole body relaxed at the thought.

I smiled with her, then glanced in Annie’s direction.

When it came time to push, Ajak started crawling the room in pain and complaining her hips ached. So I applied pressure and massaged where I could. Eventually she fell to her hands and knees and rocked a bit.

It was close.

Annie sat in the corner of the room wide-eyed in wonder. She looked hesitant and nervous, but hid it well. Ajak was silent but active --very active.

Suddenly there was a noticeable change in her grunts. It was time.

Since she was already on the floor, I slipped a pad under her and seconds later her little girl was in my hands.

I had Ajak sit down on the pad to wait for the placenta, as our translator milled about handing me things.

Her girl was healthy and strong; she yelped sporadically as I wiped her off. Trying to keep her warm, I covered her tiny frame and waited.

As we waited I continued to teach Annie the Dinka birthing traditions (as there are as many for after the birth as there are during).

With time, the placenta was born and we cut the cord. Weighing her and wrapping her tightly in a blanket, I handed her over to Ajak's doula-friend.

She started complaining that she had spittle in her mouth, but then caught herself. Apologizing, she stopped half way through and smiled at me. “I won’t be negative anymore,” she told me with a smile that reached her eyes, “because I see that with you I don’t have to worry.”

What a blessing!

I continued to teach Annie the ropes while Ajak breastfed on the floor. At one point, she looked up at me glowing and said, “I’m so happy.”

I smiled back and told her I was happy too --so very happy!

I’m happy I got to be a part of one last birth before I left. I’m happy I got to show Annie the typical birthing style as well. But more than anything, I’m happy Ajak got to deliver in a way that made her happy.

Lord, bless Annie and Axilla (the other midwife that came a bit later on). Help them to love the women well. Teach them how to be culturally sensitive to the Dinka traditions. Bless them, Lord. And use them powerfully for Your glory. Amen.

Ajak was my 230th birth in South Sudan. I’m going to miss them.